Video Consults: Innovating and Personalizing Patient Care

High-tech communication solutions allow pharmacists and patients to work together to overcome barriers to the administration and management of complex medication regimens.

Patients newly diagnosed with chronic conditions such as rheumatoid arthritis (RA), multiple sclerosis, HIV, or hepatitis C are often intimidated at the thought of managing their complex, high-cost specialty medications and adhering to their prescription plans. It is a lot to take in. But these medication regimens are the front line of defense, as they offer the most economical and least intrusive way to treat these and other diseases.

In the IMS Institute for Healthcare Informatics June 2013 study it was reported that improving the responsible use of medicines has the potential to reduce overall health expenditures each year by $213 billion. Of that, medication nonadherence was the largest avoidable cost. Patients not adhering to their doctors’ medication guidance experienced complications that led to an estimated $105 billion in annual avoidable health care costs.¹

We know that there are many factors that impact adherence, including both personal and intrinsic barriers. Every individual responds differently, even to the same treatment plan. Ten people with the same condition, prescribed the same medication, will all respond differently based on a number of factors—behavioral attributes, financial considerations, comorbidities, and other drivers. When you add in intrinsic barriers—such as treatment complexity (multiple medications/ dosing schedule), care coordination complexity (multiple providers), and cost—many patients do not take their medications as recommended.

When the prescribed medication involves complicated administration and/ or storage requirements, the likelihood of adherence decreases even more, as all of these forces together will influence patient behavior.

With these and other barriers in mind, BriovaRx, Catamaran’s specialty pharmacy offering, has created personalized and innovative interventions to help ensure that members are supported in the ways they are most likely to be successful. The key to this personalized support is customized communication. We know that communicating with patients in ways they prefer increases the likelihood that the information will resonate.

AN INDUSTRY FIRST

Our latest offering, Briova Live, is a great example of personalized communications. Briova Live is an industry first innovation that connects pharmacists to patients through an online video consult. This personalized connection allows patients to be in the comfort of their own home while being taught how to administer and manage complex medication regimens.

This high-touch support model gets new-to-therapy specialty patients off to the right start. When a patient is prescribed a new specialty medication from their physician, BriovaRx coordinates a video consult appointment with a clinical pharmacist who is trained in online patient engagement and motivational interviewing.

A box containing the medication and all needed supplies is then delivered to the patient’s house and the patient and pharmacist are connected for the consult. The patient just needs an Internet connection and a laptop, desktop, or tablet to use the service. Each session takes place over a secure and private connection to ensure patient privacy.

This initial consultation places a pharmacist “alongside” the patient as the first medication shipment is opened. The pharmacist “unboxes” a set of supplies that are identical to what the patient has received in tandem with the patient. The personalized consult includes a review of medication and supplies, assistance with assembling any devices, injection training with on-the-spot feedback for proper technique, education about side effects and drug interactions, important details about proper medication storage, and support, encouragement, and reassurance throughout the process.

Additionally, spouses and caretakers are invited to participate to learn about medication and injection techniques. Family participation serves as an additional set of eyes and ears, usually focusing on the unboxing and learning the injection technique. It can ensure that the communication is being well understood and accepted. Family participation also helps ensure that the patient can continue the regimen on his or her own post consult. The session can also be recorded, allowing the patient to review and/or share the instructions they received with their family or caregivers at a later date.

PERSONAL ATTENTION AND FEEDBACK

Patients value the personal attention and immediate feedback they receive from the pharmacist. It also allows them to develop a relationship with their pharmacist, so they feel comfortable asking questions in the future and getting the personalized care they need, which also can dramatically increase compliance. If a patient knows how to take their medicine, they are more likely to take it.

RA is one of the top conditions counseled through Briova Live. Treatment goals for RA patients are to relieve pain, reduce swelling in the joints, slow down or stop joint damage, and help people feel better and stay active. Patients are often prescribed injectable specialty medications to alleviate their symptoms and reduce disease progression.

To demonstrate the true value of Briova Live, let me share 2 RA patient examples with you:

Patient story #1: One of our RA patients was very worried about doing a self-injection, as she had a fear of needles. Through the video consult, one of our specialty pharmacists was able to talk to her about injections, and as the consult went on, the patient became more comfortable with the thought of doing the injection. By the end of the call, the patient was actually comfortable enough to do the injection while the pharmacist watched on the video consult. She just lifted up her shirt right there and gave herself 2 injections. Afterwards both the patient and the pharmacist had wonderful feedback to share:

• “I liked the video chat with the pharmacist even better than having someone come to my home. I was nervous, but was able to give myself my first 2 injections.” —RA patient

• “The patient actually did her injections on the video chat with me. The patient commented that she liked this type of interaction better than having a nurse in her home (as a nurse would hang over her and make her uncomfortable); but she was comfortable enough to do an injection on her stomach on the video chat. She was very appreciative and happy with the video chat. I was touched by the opportunity to see her and to witness her giving herself the injections, as she was nervous about it. I truly enjoyed the experience.”

—Pharmacist

Patient story #2: We had another RA patient who was worried about doing the injection and what the actual injection device looked like. Our pharmacist was able to have a sample injection device with fake medication in it and was able to take the patient through the injection step by step using an injection device that looked just like the one that the patient had. This patient’s doctor didn’t offer injection training, but we were able to assist both the doctor and the patient by providing the support and education needed to self-administer the medication.

We are currently the only specialty pharmacy offering video consultations. Most pharmacies offer either a consultation at the retail counter, over the telephone, through written communication, or with a home health nurse. Our approach personalizes the experience through video, creating a direct connection between the pharmacist and patient without the patient feeling overwhelmed by having someone physically in their home. We know that this engagement and patient confidence is critical and helps lead to increased medication adherence and positive health outcomes.

Receiving a box full of medication, syringes, waste disposal boxes, and other medical equipment can feel intimidating and overwhelming to a patient. We strive to make our patients feel comfortable and confident, and that is exactly what we are hearing from members as they report high levels of satisfaction with our high-tech, yet highly personal patient support approach.

Patient feedback has been very positive:

• 100% said that as a result of the video consultation, they understand how to better use their medicine.

• 90% said they were confident in their ability to use their medicine post consult.

• 100% said the video consult service is an improvement over the more traditional telephone conversation.

• 100% said that they would recommend the service to friends and family.

BriovaRx launched the video consults as a pilot program in April 2013. Because of the positive feedback and demand for the service, we have been expanding the video consult service more broadly. We are also building dedicated video consult bays on our new, state-of-the-art flagship—the specialty facility in Jeffersonville, Indiana—to bring this service to a broad audience of patients.

Relationship development with the patient, trust, personalized communication, and interventions are critical to influencing the positive health behavior of medication therapy adherence. Our video consult helps ensure patient adherence with new therapies, as they know how to administer their medications. In an industry that has been focused on delivery channels and transactions, we at BriovaRx aspire to be something different. SPT

References:

1. Avoidable costs in US healthcare. IMS Health website. www.imshealth.com/deployedfiles/imshealth/Global/Content/Corporate/IMS%20Institute/RUOM-2013/Avoidable_Costs_Infographic.pdf. Published June 2013.

About the Author

Albert Thigpen, RPh, is senior vice president, pharmacy operations and industry relations of Catamaran, the nation’s fourth-largest pharmacy benefits manager (PBM), serving more than 25 million members. Mr. Thigpen manages the firm’s partnerships within the pharmaceutical industry, including cost of goods relationships across the commercial PBM, government, and public sector, as well as specialty business verticals. In addition, Mr. Thigpen directs business strategy and initiatives for Catamaran’s home delivery footprint, including traditional mail order and specialty pharmacy.

As the successful merger between 2 industry-leading PBMs—SXC Health Solutions and Catalyst Health Solutions—Catamaran is the leading alternative to the traditional approach of other PBMs, with the purchasing power of the largest players inside a flexible, agile, client-centered delivery model. Joining SXC Health Solutions in 2011, Mr. Thigpen has extensive expertise in the PBM management arena, ranging from traditional practices to integrated specialty offerings to Medicare Part D. He was instrumental in shaping SXC’s specialty pharmacy business by leading the integration of several specialty acquisitions. At Catamaran, he is taking an active role in establishing the $13 billion company as a leader in delivering prescription drug cost savings to clients and consumers through its expanded leverage across the pharmaceutical supply chain.

Prior to joining SXC Health Solutions in 2011, Mr. Thigpen spent more than 10 years with the CVS Caremark organization where he served as senior vice president of industry relations and developed the pharmaceutical manufacturer strategy for the PBM, Medicare Part D, and specialty business units. He has extensive merger and acquisition expertise, developing and assisting in health care’s most noteworthy transactions: Caremark and AdvancePCS, Caremark and CVS, and CVS Caremark and Universal American Corporation.

Mr. Thigpen’s long-standing career inhealth care has been fully devoted to pharmacy and managed care. He has held leadership positions with HealthNet in California, Kaiser Foundation Health Plans in Texas and Ohio, and the Cleveland Clinic Foundation. He is a licensed pharmacist and alumnus of the University of Toledo, where he earned his bachelor of science degree. As an active advocate in the health care profession, Mr. Thigpen actively participates and supports organizations such as the Pharmaceutical Care Management Association, Academy of Managed Care Pharmacy, and Pharmacy Benefit Management Institute.